Date Presented 3/31/2017
Approximately 50% of all prescription medications dispensed each year are taken incorrectly. As adolescents begin to show more independence in self-care, it is important for occupational therapists to accurately assess medication adherence with tools that are backed by a systematic recommendation.
Primary Author and Speaker: Whitney Blankenship
Contributing Authors: Dianna Lunsford, Kristin Valdes
PURPOSE: Approximately 50% of prescription medications dispensed each year are taken incorrectly, costing the United States over $100 billion in patient rehospitalization and treatment. As adolescents begin to show more independence in self-care, it is important to be able to accurately assess their medication adherence. Use of appropriate and valid assessments is necessary to understand and overcome the gap in adherence. Skills in education, assessment, and treatment related to medication adherence and self-care place occupational therapists in a crucial role to making a change. Conclusive evidence regarding medication adherence assessments for adult populations has been found, but until now, there has not been a systematic recommendation regarding the most effective assessment for adolescents.
DESIGN: The design of this research is a systematic review of studies published from January 1, 2005, to July 1, 2016, in English. Additional study inclusion criteria consisted of the following: Participants were ages 13–18 yr and had taken at least one prescription medication for at least 1 mo, the assessment tool used in each study needed to be standardized, and details on the tool and patience adherence rating results must have been outlined. All patient diagnoses were included for this review. Finally, randomized controlled trials, retrospective studies, prospective studies, cohort studies, and other qualitative systematic reviews relating to medication adherence were included in this review.
METHOD: To identify qualifying research for this review, CINAHL, PsycNet, PubMed, and MEDLINE search engines were systematically and independently searched by two researchers. The following key words or medical subject headings (MeSH) were used in the search: adolescents, medication adherence, medication compliance, medication adherence assessment, medication compliance assessment, medication management, and medication management assessment. The following information was extracted from selected studies: study purpose, diagnostic group demographics (age, sex, diagnosis), assessment tools used, and calculated statistical and clinical significance. After all studies were selected, a list of standardized assessment tools was evaluated by two reviewers using the Outcome Measures Rating Form (OMRF; Law, 2004). This evaluation tool classifies the focus of outcome measures using the International Classification of Functioning, Disability and Health (World Health Organization [WHO], 2001) into body functions, body structures, activities and participation, and environmental factors. Medication adherence, an aspect of health management, is categorized under activities and participation in regard to self-care (WHO, 2003).
The focus of each assessment as outlined by the OMRF extracts the purpose, population, diagnostic groups, and evaluation context. Clinical utility of the assessments considers the clarity of instruction, format, time to complete, examiner qualifications, and cost. Scoring and standardization are evaluated to understand the weight of scores, levels of measurement, norms available, and thoroughness of the assessment manual. Finally, reliability and validity are evaluated through the collection of research using these assessment tools. The OMRF gives a holistic view of assessments, outlining their strengths and weaknesses in order to conclude the most effective and appropriate medication adherence assessment for adolescents age 13–18.
RESULTS: Data collection for this systematic review will begin after July 1, 2016. After the studies have been reviewed, the results will be summarized and displayed in four charts using the OMRF as a guide. Anticipated completion date for this study is December 2016.
CONCLUSION: The conclusion and impact statement will be developed after the review is completed.
References
Bagatell, N., & Sanders, M. (2012). The role of occupational therapy in managing medication for children. OT Practice, 17(14), 9–12.
Cole, J. (2011). Extending the role of the occupational therapist in the promotion of collaborative medication management to facilitate occupation. British Journal of Occupational Therapy, 74, 540–542. https://doi.org/10.4276/030802211X13204135680983
Law, M. (2004). Outcome Measures Rating Form. Hamilton, Ontario, Canada: CanChild Centre for Childhood Disability Research. Retrieved from https://www.canchild.ca/en/resources/137-critical-review-forms-and-guidelines
Taddeo, D., Egedy, M., & Frappier, J.-Y. (2008). Adherence to treatment in adolescents. Paediatrics and Child Health, 13, 19–24. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528818/pdf/pch13019.pdf
World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.
World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. Geneva: Author.
